Foreign Body Ingestion: A Multifactorial Dilemma

Introduction: It is estimated that approximately 1500 deaths related to accidental FB ingestion occur annually; however, there is a lack of data regarding the incidence, burden, complications, and readmission rates for FB ingestion in patients with purposeful FB ingestion. Methods: An observational, retrospective chart review examined patients ages 18 years or older with a diagnosis of purposeful FB ingestion of the alimentary tract that received medical care at The Ohio State University Medical Center (OSU) between 10/31/2017 to 10/31/2022. Exclusion criteria included food bolus ingestion. Statistical analysis using means and proportions were used to describe foreign body ingestion and outcomes. Results: This study included 99 subjects resulting in 238 hospitalizations due to FB ingestion. The majority were male (75.8%), white (83.8%), incarcerated (62.6%) and a median age of 31.7 years (IQR 25.8-39.1). The most commonly ingested items were metallic objects (i.e. paperclips, needles, tweezers n=78, 32.8%), pens or pencils (n=64, 26.9%) and razor blades (n=53, 22.3%). According to ASGE guidelines, removal was classified as emergent (n=31, 13.2%) urgent (n=182, 77.8%) and non-emergent (n=21, 9.0%). Adherence to timing of removal was 93.2% including 96.2% of urgent and 71.0% of emergent removals. The average time to complete endoscopic FB removal was 75.1 minutes and the cost of endoscopic equipment (not including procedure or anesthesia) for FB removal was $157.40. The immediate complication rate was 2.6% (n=6) and was most likely benign mucosal tears (66.7%) requiring clips for hemostasis/repair. Immediate complications were not more likely to occur in endoscopies that were non-adherent to ASGE guidelines for timing of FB removal. Thirty (44.1%) patients had at least one readmission for FB ingestion. Ten (10.1%) patients had recurrent FB ingestion during the same admission as the initial extraction. Conclusion: Purposeful FB ingestion poses a burden on the health care system: prolonged length of endoscopic procedures, complications from ingestions requiring surgical interventions, and recurrent FB ingestions leading to repeat hospitalizations. Further research on multidisciplinary approach to patients with recurrent purposeful FB ingestions should be completed to reduce the impact to the healthcare system.